Recent Advances in Cardiovascular Surgery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 25 May 2026 | Viewed by 383

Special Issue Editors


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Guest Editor
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
Interests: cardiac surgery; aortic valve; CABG

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Guest Editor
Cardiac Surgery Unit, Cardiothoracic Department, ASST Spedali Civili, Brescia, Italy
Interests: cardiac surgery; sutureless and rapid deployment valves; minimally invasive cardiac surgery; mechanical circulatory support; mitral valve repair; arrhythmia surgery
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Special Issue Information

Dear Colleagues,

Cardiovascular surgery continues to evolve at a remarkable pace, driven by advances in technology, imaging, and interdisciplinary collaboration. What was once the domain of highly invasive procedures has expanded to include a broad spectrum of innovative, less invasive strategies, reshaping the treatment landscape for coronary artery disease, valvular heart disease, aortic pathology, and heart failure.

The aim of this Special Issue of Medicina is to highlight recent breakthroughs and contemporary trends across the field of cardiovascular surgery. From conventional open procedures to minimally invasive (robotic) and hybrid techniques, we seek to explore how surgical practice is adapting to meet the demands of increasingly complex and diverse patient populations.

This is a period of significant innovation, not only in surgical approaches but also in device development, perioperative care, and long-term management. Advances such as endovascular aortic repair, robotic-assisted procedures, sutureless valve implantation, and mechanical circulatory support systems are redefining what is possible in modern cardiac surgery. At the same time, growing emphasis on personalized medicine, frailty assessment, and enhanced recovery protocols underscores the need to balance technical progress with patient-centered care.

We welcome submissions of original research, clinical studies, and comprehensive reviews that provide new insights into cardiovascular surgery. Topics of interest include, but are not limited to, minimally invasive and transcatheter techniques, novel surgical devices, perioperative optimization strategies, long-term outcomes, and innovations in the treatment of structural heart, aortic, and coronary disease.

Dr. Massimo Baudo
Dr. Lorenzo Di Bacco
Guest Editors

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Keywords

  • cardiac surgery
  • surgical outcomes
  • heart valves
  • cabg
  • left atrial appendage
  • aortic diseases
  • heart failure
  • new technologies

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Published Papers (1 paper)

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Review

20 pages, 1061 KB  
Review
Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management
by Karina E. Rivera Jiménez, Yahaira M. Mamani Ticona, Giancarlo Gutierrez-Chavez, Cristian O. Astudillo, Edisson Calle, Giancarlo A. Torres Heredia, Dario S. Lopez Delgado, Oriana Rivera-Lozada and Joshuan J. Barboza
Medicina 2025, 61(12), 2088; https://doi.org/10.3390/medicina61122088 - 23 Nov 2025
Viewed by 256
Abstract
Background: Unfractionated heparin (UFH) is the standard anticoagulant during cardiopulmonary bypass (CPB). A clinically relevant subset develops heparin resistance (HR)—failure to reach adequate anticoagulation with usual UFH—raising thrombotic risk and complicating perioperative care. Objectives: To synthesize contemporary evidence on the mechanisms, [...] Read more.
Background: Unfractionated heparin (UFH) is the standard anticoagulant during cardiopulmonary bypass (CPB). A clinically relevant subset develops heparin resistance (HR)—failure to reach adequate anticoagulation with usual UFH—raising thrombotic risk and complicating perioperative care. Objectives: To synthesize contemporary evidence on the mechanisms, clinical implications, and perioperative management of HR in adult cardiac surgery with CPB. Methods: This narrative review synthesizes contemporary evidence on the epidemiology, mechanisms, recognition, and management of HR in adult cardiac surgery with CPB, emphasizing clinically actionable points. Results: Incidence varies across centers and definitions. Mechanisms include antithrombin (AT) deficiency or consumption and AT-independent drivers such as systemic inflammation or sepsis, protein-loss states, thrombocytosis, hyperfibrinogenemia, obesity, prior heparin exposure, and drug interactions. Sole reliance on activated clotting time (ACT) may misestimate anticoagulant effect; anti–factor Xa (anti-Xa) assays or heparin titration systems improve assessment when available. Management is stepwise: UFH dose escalation; targeted AT supplementation (or fresh frozen plasma where concentrates are unavailable); and transition to direct thrombin inhibitors when HR persists or UFH is contraindicated. Protocolized pathways and multidisciplinary coordination reduce delays and adverse events. Conclusions: HR is a multifactorial, common challenge in CPB. Pre-bypass risk assessment, multimodal monitoring, and an algorithm prioritizing UFH optimization, AT repletion, and timely use of direct thrombin inhibitors provide a pragmatic framework to limit thrombosis and bleeding. Harmonized definitions and comparative trials remain priorities. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Surgery)
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